ASD (or autism) is a complex developmental condition that typically emerges in early childhood. It is observed to be four times more likely in males.
ASD manifests in a multitude of ways and is characterized by a broad array of behaviors, such as repetitive activities, pervasive interest, and heightened sensitivity to lighting, color, texture, or order.
In terms of functionality, individuals with ASD were previously categorized as having either high-functioning autism or low-functioning disorder. However, these terms are no longer officially used to diagnose people with ASD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and other guides.
It’s important to note that these terms are no longer used to describe ASD because the condition is not adequately described by varying degrees of functioning. Since the autism spectrum encompasses a wide range of symptoms and challenges, the use of these terms is not adequate.
However, to qualify for SSDI benefits, individuals must demonstrate that their autism prevents them from working.
SSA’s Blue Book Requirements for Autism
According to the SSA’s Blue Book, there are two basic requirements to qualify for SSDI with autism:
- Communication and Behavior Documentation
You are required to provide documentation of limitations in both verbal and non-verbal communication and limited social interaction, as well as restricted or repetitive patterns of behavior, interests, or hobbies.
- Proof of Severe Impairment
You should provide proof from a doctor that you experience severe impairment in at least one or two of the following areas: Your ability to take in, process, and use information
- Your ability to interact with customers, your employer, and colleagues at work
- Your ability to regulate yourself in different situations
- Your ability to concentrate on your work and stay committed to certain tasks
If you have severe limitations in a particular area, you may not be able to function independently for a long time. Even if you have marked limitations, you may be able to work independently, but not for a sustained period.
Additional Considerations
While you cannot provide documentation for every instance in which your autism prevents you from working, you will need an official record or other proof that your disorder prevents you from working. It’s also important to note that under the guidelines of the SSA, autism spectrum disorder can qualify for SSDI even without the presence of a language or intellectual disorder.
Do Autistic Children Qualify for SSDI?
The SSA Childhood Blue Book includes autism as one of the conditions that may qualify for Social Security benefits. The Blue Book serves as a guide from the SSA to determine which conditions are eligible for these benefits.
Qualification Criteria for Children with Autism
Section 112.10 of the Blue Book outlines the specific qualification criteria for children with autism. To qualify for SSDI, comprehensive medical documentation is required that demonstrates qualitative deficiencies in the following areas:
- Verbal communication
- Non-verbal communication
- Social interaction
- Restricted, repetitive patterns of behavior, interests, or activities
Additional Requirements
In addition to these criteria, a child must show extreme limitation in one, or marked limitation in any of the following areas to further qualify as autistic:
- Ability to interact with others (such as following directions, playing, etc.)
- Ability to learn and retain information
- Ability to focus and complete tasks
- Ability to adapt to situations (such as controlling emotions)
Regular Checkups and Transition to Adult Rules
The SSA conducts regular checkups on a child’s health until the age of 18. At this age, the benefits may continue, but adult rules apply. This transition acknowledges the evolving needs and abilities of individuals with autism as they grow older.
What if My Autism Does Not Meet the Criteria?
Even if your autism does not meet the specific Blue Book criteria mentioned earlier, applying for Social Security Disability benefits remains an option. When applying as an adult, it’s important to demonstrate that your autism prevents you from working.
Securing disability benefits can be a challenging process. Even individuals whose autism does meet the criteria may face a high likelihood of having their initial application denied. However, persistence is key. Studies indicate that between 70 and 80% of applications are denied upon initial submission.
Remember, you have the right to file an appeal at any time. This gives you the opportunity to present your case in front of a judge. In fact, more than half of the applicants are granted approval by a judge after filing an appeal for disability benefits.
Understanding the Benefit Amount for Autism Disability Claims
In 2023, the maximum monthly amount that individuals can receive in the form of SSDI is $3,600. This cap on the benefit amount remains consistent, irrespective of the condition you have or whether you apply with one or more conditions.
However, there are other considerations that factor into determining the exact amount of your benefits. These considerations cause the benefit amount to vary depending on the circumstances of each case. One such circumstance is the total tax contributions you’ve made to the Social Security system.
For instance, when calculating your SSDI benefits, the SSA first calculates your Average Indexed Monthly Earnings (AIME). This is the average of your 35 highest earning years. This sum is then used to calculate your Primary Insurance Amount (PIA).
How To Prove Your Autism Disability to the Social Security Administration
There are several ways to demonstrate your autism to the SSA. These include:
Doctor’s Statement
The SSA may have questions for your doctor that will help clarify your autism symptoms. It’s recommended that you obtain a detailed note from your doctor outlining your symptoms and how they impact your ability to maintain employment. This statement should be comprehensive and not merely an affirmation of your condition.
Medical Records
The SSA relies heavily on your medical history and records when determining your eligibility for benefits. Your medical record should provide extensive evidence of your autism diagnosis, including documentation of hospital visits, treatment records, medication, and a description of your symptoms. Most importantly, your record should highlight the severity of your autism and how it prevents you from working.
Psychological Evaluation
Autism can have psychological impacts, affecting your ability to understand, process, and evaluate information. You may communicate in a way that others find challenging to understand. Autism may also impact your ability to concentrate and maintain a consistent work pace. Depending on the severity of your condition, you may or may not be able to fit into a particular role. You can demonstrate this with the medical evidence of psychological testing and evaluation included in your SSDI application.
In addition, the SSA may also send you for a paid consultative exam (CE). A CE involves a physician or specialist examining your symptoms and their impact on your ability to work. If your mental condition, including any symptoms you may be experiencing, is extensively documented and submitted with your application, this could prevent the SSA from sending you for a paid consultative exam.
Conclusion
While it is possible to qualify for SSDI benefits with autism, extensive medical evidence is required for approval. It’s recommended to work with an experienced disability lawyer who can help maximize your chances of SSDI approval.
Remember, these processes are designed to provide support and resources, and do not define an individual’s capabilities or potential. With the right support, individuals on the autism spectrum can lead fulfilling and meaningful lives.
