By Lori B. Painter, Lawyer at Metzger Wickersham
If you or a loved one is living with autism, you may be wondering what rights autistic people have under the Americans with Disabilities Act (ADA). Perhaps you want to know if autism qualifies for disability benefits from the Social Security Administration (SSA).
Individuals with autism may be eligible for government assistance. Understanding how to navigate these potential options can help people access these services.
Autism is a disability under the ADA. Some adults and children with autism can access Social Security benefits, including disability benefits and Supplemental Security Income (SSI). Continue reading to learn more about autism and available disability benefits.
What Is Autism?
Autism spectrum disorder (ASD) is a complex developmental disorder that usually appears in early childhood. Males are four times more likely to develop the condition.
Autism can affect people differently with a broad range of conditions. It's characterized by difficulties with social interaction and communication and by unusual behavior patterns such as repetitive activities, pervasive interests, and extreme sensitivity to sounds, textures, lights or smells. However, the severity of symptoms can vary, and no two autistic individuals are alike.
Autism, Asperger Syndrome (AS), and Pervasive Developmental Disorder (PDD-NOS) are three conditions that fall within the autism spectrum.
Although there's no cure, research shows that diagnosis and early intervention have considerable long-term positive effects on symptoms and skills. Even children under two years old can be diagnosed with ASD in some cases.
Applying for Social Security Disability Benefits with Autism
The Social Security Administration (SSA) provides two benefits for individuals with disabilities that adults and children with autism may be eligible for:
Social Security Disability Income (SSDI)
SSDI supports people who worked previously but who had to stop working due to disability. The SSA bases this benefit on the individual's income before they became disabled. They may also base it on the person's parental income if the disability began before age 22.
Supplemental Security Income (SSI)
SSI helps disabled people with low incomes. Families can apply for SSI for children with autism to help them pay for the additional resources the child needs. Keep in mind that the family’s income will be taken into consideration and their income cannot reach the SSI limit. Qualification doesn't depend on someone's previous employment. Rather it depends on household income and resources. People receiving SSI may also qualify for medical benefits, such as Medicaid. The amount someone receives each month for their SSI benefit differs between states, with some states supplementing the amount for children with autism.
Qualifications for Children with Autism
Autism is listed as a qualifying condition in the Childhood Blue Book. The Blue Book is the SSA’s medical guide for determining if an applicant is eligible for Social Security benefits.
There are strict qualification criteria for children with autism listed in Section 112.10 of the Blue Book.
To be eligible for SSI, a child with autism must have thorough medical documentation of qualitative deficits in the following:
- verbal communication
- non-verbal communication
- social interaction
- Restricted or repetitive patterns of behavior, interests, or activities
Additionally, a child with autism must have “extreme” limitation in one, or marked limitations in any two of the following criteria:
- Understanding, remembering, or applying information
- Interacting with others (taking directions, playing with other children, etc.)
- Concentrating and completing tasks
- “Adapting oneself,” which means controlling emotions
The SSA reviews the child's health around every three years, until age 18. At this point, adult rules apply, although the SSI coverage may continue.
Qualifications for Adults with Autism
This disorder is included in the SSA’s Blue Book of qualifying conditions under Section 12.10, Mental Disorders.
To qualify for SSI any individual over the age of 18 must be able to prove that they are unable to work a simple unskilled job, have a limited income, and they must submit medical documentation of their diagnosis showing all of the following:
- difficulties in social interaction
- difficulties in verbal and nonverbal communication and in imaginative activity
- restricted range of activities and interests
You will also need to provide documentation of extreme limitation of one or more of the following areas of mental functioning:
- Understand, remember, or apply information
- Interact with others
- Concentrate, persist, or maintain pace
- Adapt or manage oneself
Most adults with autism spectrum disorder will not qualify for Social Security Disability Insurance (SSDI). In order to qualify for SSDI, you must have held a job for the required number of quarters for a person of your age. Since autism is present from birth, an applicant with a significant work history may find it hard to prove that his disorder affects his ability to hold a job. There is an exception: Adults with autism may apply for SSDI as an adult disabled child if a parent is deceased or receiving retirement or disability benefits.
Gathering the documentation you need to support an SSI or SSDI claim can be frustrating. Explaining your symptoms is a challenge. For this reason, most autistic applicants are rejected the first time they apply for benefits.
If you are trying to obtain Social Security benefits for a child or an adult with autism it is important to have an attorney help you with the process.