What is Autism Spectrum Disorder?
Autism spectrum disorder is a neurological and developmental disorder which is marked by persistent challenges with social communication, restricted interests, and repetitive behavior. Individuals with autism spectrum disorder typically face two core symptoms: challenges with social communication and interaction skills, and restricted and repetitive behaviors. These individuals may struggle to initiate conversations, express their interests or emotions, empathize with others, make eye contact during conversations, understand emotions of others, regulate their tone of voice, or make friends with their peers. Often individuals with autism spectrum disorder have extreme distress at even small changes in their plans or routine, have ritualistic behaviors such as watching the same videos over and over again, have intense and highly focused interests in very specific topics, and may have repetitive movements, play, or speech patterns referred to as stimming.
What are the Levels of Clinical Severity?
Autism spectrum disorder is very individualistic in how the disorder affects the daily lives of those who are diagnosed. While there is a great deal of variation, generally speaking there are three levels of severity which are categorized as Levels I through III, with Level I being the least severe and Level III being the most severe. These levels are meant to identify the level of assistance or care the individual would need to overcome their social and communicative impairments. As such, Level I means that the without supports in place the individual’s autism would cause difficulties in social settings, Level II means that even with support the individual’s autism creates deficits in their social or communications skills, and Level III means that even with very substantial support the individual will be very limited in their social interaction and navigation skills and that their behavior seriously interferes with their functioning.
Can Autism Spectrum Disorder Qualify an Individual for Social Security Disability Benefits?
Individuals with autism spectrum disorder may qualify for Social Security Disability benefits if that individual can prove that they meet the requirements either of the Social Security Administration’s applicable Listing of Impairments, or if the individual is found disabled because his or her impairment is medically equivalent to a Listing.
The Listing of Impairments differentiates autism spectrum disorder based on the age of the claimant, as Listing 12.10 is the adult listing and Listing 112.10 is the listing for children, and available for children between the ages of 3 through 18. Both listings require that the autism spectrum disorder diagnosis be substantiated with medical documentation of the individual’s deficits in verbal communication and social interaction, and limitations in understanding, remembering, and applying information, interacting with others, concentrating, persisting or maintaining pace, and adapting to new conditions or managing his or herself.
If someone has been diagnosed with autism spectrum disorder but does not meet the strict requirements of the Listing of Impairments, they may still receive Social Security Disability benefits. Both adults and children may qualify for benefits if their impairment(s) is the medical equivalent to the impairment of the listed criteria. For autism spectrum disorder, medical equivalence may be established where the claimant’s impairment nearly meets the Listing requirement, but falls short due to either the lack of one required finding, or that one of the required findings was not severe enough. In either of these circumstances, the judge may review all relevant case facts, except for the age, education, and work experience of the claimant to determine if he or she has other findings related to his or her impairment that are at least of equal medical significance to the required criteria.
Additionally, for individuals seeking Social Security Disability benefits for a child diagnosed with autism, even if the child’s impairment is not found to be medically equivalent to a particular listing, he or she may still qualify for Social Security Disability benefits if their impairment is determined to be functionally equivalent to a listing by conducting a functional limitations analysis. This analysis considers how the child functions in six domains identified as: acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for his or herself, and health and physical well-being. Notably, if the analysis is conducted regarding a child then that child will be compared to other same-aged children who are not impaired.
If you or someone you know has autism spectrum disorder and would like to speak with an attorney about filing for Social Security disability benefits, call the law office of Michael Monce at (859) 344-8090.
References:
National Institute of Mental Health, Autism Spectrum Disorder, December 2024, https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd.
Autism Speaks, ASD levels of severity, https://www.autismspeaks.org/levels-of-autism.
Autism Speaks, Signs and Symptoms of Autism Spectrum Disorder, https://www.autismspeaks.org/autism-symptoms.
Social Security Administration, Listing of Impairments 12.10 Autism spectrum disorder, https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12_10.
Social Security Administration, Listing of Impairments 112.10 Autism spectrum disorder in children, https://www.ssa.gov/disability/professionals/bluebook/112.00-MentalDisorders-Childhood.htm#112_10.
20 CFR 416.926, https://www.ssa.gov/OP_Home/cfr20/416/416-0926.htm.
20 CFR 416.926a (c)-(d), https://www.ssa.gov/OP_Home/cfr20/416/416-0926a.htm