Autism and Social Security Disability

Autism - Condition

Autism Spectrum Disorders (ASDs) are a diverse group of neuro-developmental disabilities that affect how the brain processes information. ASDs can cause significant behavioral, social, and communication difficulty and can appear in many different forms. According to the DSM-5-TR, the diagnostic criteria for ASDs is based on one’s functioning in (1) restricted interests/repetitive behaviors, and (2) social communication.

The DSM-5-TR is the manual used by mental health professionals in the United States that provides all of the standard classifications of mental disorders. Being an acronym that is most commonly used to refer to this manual, DSM-5-TR stands for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision.

There are five major disorders in the Autism Spectrum: 

• Asperger’s Syndrome (AS) – reclassified by the DSM-5 as Level 1 ASD
• Rett Syndrome 
• Kanner’s Syndrome – also referred to as Classic Autistic Disorder
• Pervasive Developmental Disorder-not otherwise specified (PDD-NOS)
• Childhood Disintegrative Disorder – a rare condition that was integrated into ASD in the DSM-5.

Asperger’s Syndrome (AS)  
Prior to 2013, Asperger’s syndrome was the term used to describe what is now Level 1 ASD. Level 1 ASD (i.e., Asperger’s Syndrome) is characterized by young individuals being able to perform well in school and communicate with others, but having difficulty connecting socially with other people. The thought patterns and behaviors of people who have Level 1 ASD can be repetitive and inflexible.

Rett Syndrome   
Affecting 1 in every 10,000 women, Rett syndrome is another type of ASD that rarely affects men. Typically, Rett syndrome is diagnosed in children between the ages of 6 and 18 months when they lose abilities they had previously acquired or they begin to miss developmental milestones. Rett syndrome is now believed to be a part of a spectrum of diseases brought about by mutations in the MECP2 gene. More specifically, experts have discovered that Rett syndrome is a rare genetic neurological disorder that is characterized by a duplication of the MECP2 gene on the X chromosome. Rett syndrome is known to cause serious deficits in practically all aspects of a child’s life.

Kanner's Syndrome   
Kanner's syndrome is also known as Classic Autistic Disorder. While children who have this disorder come across as attentive, clever, and smart, the underlying symptoms of this sydrome can include: 
Uncontrollable speech 
Interpersonal and communication difficulties 
Inability to form emotional attachments with other people 
Obsession with handling objects 
A high-level of visuospatial and rote memory skills whilst having significant learning difficulties in other areas  

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)   
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) is the diagnosis that is given to children who have behavioral and learning difficulties that do not meet all of the diagnostic criteria for another specific category of ASD. In other words, PDD-NOS is the diagnosis provided for people who have “milder” symptoms compared to those with an ASD, yet they still fit into this group of disorders on the Autism Spectrum.    

Childhood Disintegrative Disorder (CDD)   
Childhood Disintegrative Disorder (CDD) is another rare condition that was integrated into ASD in the DSM-5. While the exact onset of CDD varies by individual, it is most commonly recognized and diagnosed after a child turns 3 and before they turn 4. However, CDD can occur in children at any time before they turn 10 years old. Since CDD has a later onset relative to other ASD disorders, this disorder is typically characterized by children losing some of their previously gained verbal, motor, and social functioning skills.  

It is common for people with AS (Level 1 ASD) and PDD-NOS to not be diagnosed until they reach their teen or adult years.

Is Autism A Disability?

Autism (Autism Spectrum Disorders) is a developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that is characterized by neurological differences which, thereby, affects the normal functioning of the brain.

A diagnosis of an Autism Spectrum Disorder (ASD) requires that the child exhibit at least two symptoms of impaired social interaction, one symptom of communication impairment, and one symptom of restricted or repetitive behavior.

• Impaired social interaction is basically an inability to or marked difficulty in connecting with others either verbally or non-verbally. Examples include an inability to approach others or to imitate and respond to emotions in others.
• Communication impairments can include difficulty in producing or responding to normal speech. Restricted and repetitive behaviors include purposeless movements, rearranging objects, preoccupation with a single activity, and a need for a highly structured, unchanging environment.

Autism that is not diagnosed until a person reaches teen or adult years is, by definition, a milder type than that diagnosed in a child.

Asperger Syndrome (AS or Level 1 ASD) is included in the grouping of autistic disorders as well. While some symptoms of AS are quite similar to Autism, people with AS develop the ability to think and use language, often quite well. In many cases, they can learn to function independently at school, college, and work, provided they find the right sort of structured environment (limited social contact or a solitary working environment, and a quiet work area as people with AS are sensitive to light and noise).

While some medical professionals classify Pervasive Development Disorder as a subtype of AS, people with PDD-NOS generally fall into a separate category of those with Autism or Asperger symptoms who cannot be specifically diagnosed with Autism or AS.

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Symptoms

Symptoms of ASDs vary in both type and degree and can develop gradually, but these conditions are usually recognized by age three, and often sooner. An infant with autism does not react to social stimulation with healthy behavior such as babbling, laughing, smiling, or making eye contact. Instead, an infant with autism may show a marked inability to interact, and often begins to show signs of repetitive or limited behavior.

Early intervention can help children with an ASD to cope with their condition to different degrees, but most are unable to live independently as adults. While some people with Autism are locked into continuous repetitive movements such as rocking and hand flapping and cannot interact at all socially, others have active, but odd, methods of social interactions, and sometimes exhibit highly focused interests.

Theories regarding the cause or causes of Autism range from the abnormal formation of brain synapses to genetic abnormality. Other possible causes may include external factors, such as exposure to heavy metals or pesticides.

ASDs are not curable. However, early diagnosis and treatment can help for people with an ASD to manage their disorder and symptoms.

Can You Get Disability For Autism 

Given that there is a listing for Autism Spectrum Disorder (ASD) in the Social Security Administration’s (SSA) Blue Book, ASD is considered to be a disability by the SSA. The Blue Book is utilized by the SSA when reviewing applications for Social Security disability (SSD) benefits. The Blue Book is a manual that includes listings of every medical condition and disease that the SSA considers as being severe enough to qualify for disability benefits. Within each Blue Book listing, the criteria that an applicant with that condition must meet in order to qualify for disability benefits is provided. You can access the Blue Book online via the SSA’s website.

So, can you get disability for Autism? Yes, you can. ASD is listed in the SSA’s Blue Book under Section 12.10 - Mental Disorders. That section covers mental illness disabilities. People can get disability for Autism through both disability benefits programs offered by the SSA—Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

While these two programs may sound familiar, they are quite different. SSDI benefits are designed for people who were once able to work but are no longer able to due to their disabling medical condition. Conversely, SSI benefits are meant for people who have never been able to work, and thereby have never been able to earn a living for themselves. This is why, in order to qualify and get approved for SSI, applicants’ resources, income, and assets must be below the income cap set by the SSA. In 2023, the income cap (a.k.a., “resource limit”) for SSI is $2,000 for an individual, and $3,000 for a couple. 

Filing for Social Security Disability for Autism Diagnosis

Childhood Autism

This section will provide comprehensive information on the steps to take to get disability for Autism for children. Childhood Autism is found as a listing under Section 112.10 of the Social Security Administration’s (SSA) Impairment Listing Manual, or “Blue Book.” The requirements of both Paragraph A and Paragraph B must be met in order to qualify a child for disability benefits.

Cognition is defined as the mental process of knowing, such as awareness, perception, reasoning, and judgment.

Communication is defined as a two way process of exchanging and understanding information. These abilities may be tested in a variety of ways, depending on age, with tests that can also be used to measure language and speech development.

Social functioning is defined by the Social Security Administration as the ability to form and keep relationships, cooperate with others, and respond appropriately to others.

Personal functioning is defined by SSA as the ability to perform self-case skills, such as feeding oneself, performing personal hygiene tasks, dressing, grooming, and toileting.

Maintaining concentration, persistence, and pace are defined by SSA as the ability to focus attention to a task, to persist at the task and to maintain an appropriate pace in working at the task.

Adulthood Autism

This section will provide comprehensive information on the steps to take to get disability for Autism for adults. While the requirements for a disability claim under childhood Autism is found in Section 112, there is no specific listing for a diagnosis of adult Autism (AS or PDD-NOS) in the SSA’s guide to disabling conditions. Therefore, proving total disability and achieving disability benefits based on an AS or PDD-NOS diagnosis can be difficult because there are no specific criteria for approval.

In such cases, it is critical that a claimant (or claimant’s representation) be able to demonstrate that he or she is unable to function well enough to meet the SSA’s threshold for gainful employment due to the afflicting condition, in addition to presenting a medical diagnosis documenting the severity of the claimant’s Autism.

While meeting the requirements of the SSA’s Blue Book listings is the best way to qualify for disability for autism, it may be possible in some cases for an Autistic individual to qualify for a medical vocational allowance.

Your Autism Disability Case

If you are disabled because of Autism or a related autistic disability that prevents you from working, you may well be entitled to Social Security Disability (SSDI) benefits. Although total disability based on childhood Autism can be met by meeting the conditions of the SSA listing for that condition, total disability for adult-diagnosed Autism (AS or PDD) can be somewhat more difficult to prove.

It is smart to use an attorney or advocate to present the most appropriate and complete documentation possible in front of the Disability Determination Services (DDS) to help to ensure that your Autism disability case will have the highest possible chance of success. 

Use our Social Security Benefits Calculator to find out how much money you could receive each month in disability benefits for autism. 

Additional Resources

• COLA Adjustments for 2023