(From the March 2014 issue of Research Now)
Kelly Kelleher, MD, MPH, is one of 15 nationally recognized pediatric health experts selected to be part of an IOM committee that will evaluate the Social Security Administration’s Supplemental Security Income (SSI) disability program. Specifically, the committee will help improve the program’s effectiveness in determining disability in children with mental disorders. This is the second time Kelleher is appointed to an IOM committee to weigh in on matters affecting the nation’s health.
“It is not easy to diagnose and determine the severity of impairment that results from mental disorders. This is especially true when evaluating children. How does a parent demonstrate and document impairment from obsessive compulsive disorder in his 10-year-old daughter so that he may secure disability benefits? The Social Security Administration is sponsoring this project so we can answer this and other questions related to the process currently used to determine disability in children,” said Kelleher.
Currently, when the agency evaluates disability for children, an important consideration is the severity of impairment, which is “measured according to the functional limitations imposed by the medically determinable mental impairment.”1 The agency also assesses a child’s ability to function: “If you are working and the work you are doing is substantial gainful activity, we will find that you are not disabled regardless of your medical condition or age, education, or work experience.”2 The new committee will address how well this translates to children under the age of 18 and school performance.
“The bottom line is, we cannot evaluate children by criteria applicable to adults,” says Kelleher.
The Social Security Administration’s list of mental disorders applicable to children identifies 11 categories of impairment, including psychotic, developmental and substance dependence disorders.1 Four of these categories are identified as not commonly found in children, such as schizophrenic and anxiety disorders. Were a child found to suffer from one of these disorders, he or she would be evaluated by the same criteria used to evaluate adults.
Kelleher explains that diagnoses, treatments and determination as ‘eligible’ are rapidly increasing across the country, yet both diagnosis and prognosis are difficult to determine when it comes to children with mental disorders. Current regulations establish that a child may be eligible for SSI benefits only if his or her condition(s) have been disabling, or are expected to be disabling, for at least 12 months; or are expected to result in death.3