In order for a child to be found disabled, they must either meet or functionally equal a “listing” (a list of impairments that the Social Security Administration (“SSA”) has said will result in a finding of disability if the impairment is severe enough). Thus, if a child has an impairment that is on the list, and it is as severe as required by SSA, that child “meets” the listing. However, if the impairment does not meet the specific criteria in the listing, the child can still be found disabled if the impairment functionally equals a listing. This is done by showing that the child is either “marked” in 2 of the 6 domains, or “extreme” in 1 of the six. The 6 domains are acquiring and using information; attending and completing tasks; interacting and relating with others; moving about and manipulating objects; caring for yourself; and health and physical well-being.
This article deals with the second domain: attending and completing tasks. To begin with, the SSA has defined being marked or extreme in a domain as having impairment or impairments that interferes seriously with your ability to independently initiate, sustain, or complete activities. Obviously to prove an extreme limitation, you would have to prove it interferes more substantially than a marked limitation, although the definition is more involved than this.
So, how does one prove that a child is marked or extreme in the domain of attending and completing tasks? Social Security Ruling (“SSR”) 09-4 gives us some guidance. This domain considers a child’s ability to focus and maintain attention, and to begin, carry through, and finish activities or tasks. Social Security considers the child’s ability to initiate and maintain attention, including the child’s alertness and ability to focus on an activity or task despite distractions, and to perform tasks at an appropriate pace. The child’s ability to change focus after completing a task and to avoid impulsive thinking and acting is also considered. Finally, a child’s ability to organize, plan ahead, prioritize competing tasks, and manage time is taken into account.
SSR 09-4 notes that the domain itself covers only the mental aspects of task completion; such as the mental pace that a child can maintain to complete a task. Therefore, limitations in this domain are most often seen in children with mental disorders. However, a physical impairment can also affect a child’s mental ability to attend and to complete tasks. For example, physical pain can distract a child and interfere with the child’s ability to concentrate and to complete assignments on time or at all. Medications that affect concentration or interfere with other mental processes may also affect a child’s ability to attend and to complete tasks.
This ruling also notes that while a child may demonstrate the ability to attend to some tasks, they may not be able to attend to all tasks in a particular setting. For example, they may only focus on tasks that interest them, such as video games, but not on other tasks, such as homework. Other children, especially those with autistic spectrum disorders, may show “hyperfocus” by becoming fixated on certain sounds or objects, and can pay attention to little else.
The ultimate question is whether a child’s medical impairment is so severe that it interferes seriously with the child’s ability to independently initiate, sustain, or complete a task as compared to children of the same age who do not have impairments.