Daily Rules, Proposed Rules, and Notices of the Federal Government
Although 5 U.S.C. 552(a)(1) and (a)(2) do not require us to publish this SSR, we are doing so under 20 CFR 402.35(b)(1).
SSRs make available to the public precedential decisions relating to the Federal old-age, survivors, disability,
Although SSRs do not have the same force and effect as statutes or regulations, they are binding on all components of the Social Security Administration. 20 CFR 402.35(b)(1).
This SSR will be in effect until we publish a notice in the
As we explain in greater detail in SSR 09-1p, we always evaluate the “whole child” when we make a finding regarding functional equivalence, unless we can otherwise make a fully favorable determination or decision.
We next evaluate the effects of a child's impairment(s) by rating the degree to which the impairment(s) limits functioning in six “domains.”
(1) Acquiring and using information,
(2) Attending and completing tasks,
(3) Interacting and relating with others,
(4) Moving about and manipulating objects,
(5) Caring for yourself, and
(6) Health and physical well-being.
To functionally equal the listings, an impairment(s) must be of listing-level severity; that is, it must result in “marked” limitations in two domains of functioning or an “extreme” limitation in one domain.
In the domain of “Acquiring and using information,” we consider a child's ability to learn information and to think about and use the information.
Children acquire and use information at all ages for many different purposes. For example:
• An infant shakes a rattle and learns that it will produce noise.
• A toddler learns how to play simple games.
• An older child learns how to read and do arithmetic, which enables the child to act more independently, such as to make a purchase.
• A teenager may learn the rules and mechanics for driving a car.
Learning and thinking begin at birth. In early infancy, children learn primarily by exploring their world through the senses (sight, sound, taste, touch, and smell), but also through movement and imitation. As they go on to engage in play, children learn about concepts (for example, “color,” “shape,” “size,” and “weight”). As they learn that people, objects, and activities have names, they begin to understand that names are words, and words are symbols that “stand for” what is named. Over time, this understanding of concepts and symbols prepares children for using language to learn and think. Eventually, they are expected to learn to read, write, and do arithmetic, as well as to acquire new information—not only in school, but at home and in the community.
Throughout the learning process, children have to think about and use the information they have learned. Thinking involves being able to perceive relationships (for example, over/under and near/far), reason, and make logical choices. Children may do these things by thinking in pictures, words, or both. For example, children may solve problems by watching and imitating what other people do (thinking in pictures), or by internally “talking” their way through them (thinking in words). Eventually, children should be able to use language to think about the world, understand others, and express themselves. As they learn more complex language, children should be able to combine ideas to solve problems and perform more complex tasks.
Both mental and physical impairments can affect a child's ability to acquire and use information. In addition to mental retardation and learning disorders, many other mental disorders can cause limitations in the domain of “Acquiring and using information.” For example, children with anxiety disorders may be so fearful about failing that they cannot perform learning-related tasks at school, such as taking tests or making presentations. Physical impairments, such as speech and hearing disorders, may affect a child's ability to learn, especially in the classroom. Other impairments that frequently have effects in this domain include, but are not limited to, traumatic brain injury, cerebral palsy, and meningitis.
As with limitations in any domain, we do not consider a limitation in the domain of “Acquiring and using information” unless it results from a medically determinable impairment(s). However, while it is common for all children to experience some difficulty acquiring and using information from time to time, a child who has significant but unexplained problems in this domain may have an impairment(s) that was not alleged or has not yet been diagnosed. In such cases, adjudicators should pursue any indications that an impairment(s) may be present.
Because much of a preschool or school-age child's learning takes place in a school setting, preschool and school records are often a significant source of information about limitations in the domain of “Acquiring and using information.” Poor grades or inconsistent academic performance are among the more obvious indicators of a limitation in this domain provided they result from a medically determinable mental or physical impairment(s). Other indications in school records that a mental or physical impairment(s) may be interfering with a child's ability to acquire and use information include, but are not limited to:
The kind, level, and frequency of special education, related services, or other accommodations a child receives can provide helpful information about the severity of the child's impairment(s). However, the lack of such indicators does not necessarily mean that a child has no limitations in this domain. For various reasons, some children's limitations may go unnoticed until well along in their schooling, or the children may not receive the services that they need.
Although we consider formal school evidence (such as grades and aptitude and achievement test scores) in determining the severity of a child's limitations in this domain, we do not rely solely on such measures. We also consider evidence about the child's ability to learn and think from medical and other non-medical sources (including the child, if the child is old enough to provide such information), and we assess limitations in this ability in all settings, not just in school.
As already noted, we do not consider a limitation in acquiring and using information unless it results from a medically determinable impairment(s). Therefore, we do not consider limitations that are associated with academic underachievement by a student who does not have a physical or mental impairment that accounts for the limitations.
Children who have limitations in the domain of “Acquiring and using information” may also have limitations in other domains. For example, mental impairments that affect a child's ability to learn may also affect a child's ability to attend or to complete tasks. In such cases, we evaluate limitations in both the domains of “Acquiring and using information” and “Attending and completing tasks.” Also, children who have language impairments often have limitations in both the domains of “Acquiring and using information” and “Interacting and relating with others.”
Children who have physical impairments that affect motor functioning, which we evaluate in the domain of “Moving about and manipulating objects,” may also have limitations in the domain of “Acquiring and using information.” Symptoms associated with a physical impairment(s), such as generalized or localized pain, may interfere with a child's ability to concentrate (an effect that we evaluate in the domain of “Attending and completing tasks”), and this will often also have effects on the child's ability in the domain of “Acquiring and using information.” Lastly, some medications for physical impairments may affect mental functioning, interfering with a child's ability to pay attention, remember, or follow directions. We consider these effects in the domains of “Acquiring and using information,” “Attending and completing tasks,” or both.
Therefore, as in any case, we evaluate the effects of a child's impairment(s), including the effects of medication or other treatment and therapies, in all relevant domains. Rating the limitations caused by a child's impairment(s) in each and every domain that is affected is
While there is a wide range of normal development, most children follow a typical course as they grow and mature. To assist adjudicators in evaluating a child's impairment-related limitations in the domain of “Acquiring and using information,” we provide the following examples of typical functioning drawn from our regulations, training, and case reviews. These examples are not all-inclusive, and adjudicators are not required to develop evidence about each of them. They are simply a frame of reference for determining whether children are functioning typically for their age with respect to acquiring and using information.
• Shows interest in and explores the environment (for example, reaches for a toy).
• Engages in random actions that eventually become purposeful (for example, shakes a rattle).
• Begins to recognize and anticipate routine situations and events (for example, smiles at the sight of a stroller).
• Begins to recognize and attach meaning to everyday sounds (for example, the telephone).
• Begins to recognize and respond to familiar words (for example, own name, the name of a family member, or the word for a favorite toy or activity).
• Learns how objects go together in different ways.
• Learns through pretending that actions can represent real things.
• Understands that words represent people, things, places, and activities.
• Refers to self and things by pointing and eventually naming.
• Learns concepts and solves simple problems by purposeful experimentation (for example, taking a toy apart), imitation, constructive play (for example, building with blocks), and pretend play activities.
• Makes simple choices between two things.
• Responds to increasingly complex instructions and questions.
• Produces an increasing number of words and grammatically correct simple sentences and questions.
• Develops readiness skills needed for learning to read (for example, listening to stories, rhyming words, or matching letters).
• Develops readiness skills needed for learning to do math (for example, counting, sorting, or building with blocks).
• Develops readiness skills needed for learning to write (for example, coloring, painting, copying shapes, or using scissors).
• Uses words to ask questions, give answers, describe things, provide explanations, and tell stories.
• Follows several unrelated directions (for example, “Put your toy in the box and get your coat on.”).
• Begins to understand the order of daily routines (for example, breakfast before lunch).
• Begins to understand and remember own accomplishments.
• Begins to understand increasingly complex concepts (for example, “time” as in yesterday, today, and tomorrow).
• Learns to read, write, and do simple arithmetic.
• Becomes interested in new subjects and activities (for example, science experiments and stories from history).
• Demonstrates learning by producing oral and written projects, solving arithmetic problems, taking tests, doing group work, and entering into class discussions.
• Applies learning in daily activities at home and in the community (for example, reading street signs, telling time, and making change).
• Uses increasingly complex language (vocabulary and grammar) to share information, ask questions, express ideas, and respond to the opinions of others.
• Continues to demonstrate learning in academic assignments (for example, in composition, during classroom discussion, and by school laboratory experiments).
• Applies learning in daily situations without assistance (for example, going to the store, getting a book from the library, or using public transportation).
• Comprehends and expresses simple and complex ideas using increasingly complex language in academic and daily living situations.
• Learns to apply knowledge in practical ways that will help in employment (for example, carrying out instructions, completing a job application, or being interviewed by a potential employer).
• Plans ahead for future activities.
• Begins realistic occupational planning.
To further assist adjudicators in evaluating a child's impairment-related limitations in the domain of “Acquiring and using information,” we also provide the following examples of some of the limitations we consider in this domain. These examples are drawn from our regulations and training. They are not the only limitations in this domain, nor do they necessarily describe a “marked” or an “extreme” limitation.
In addition, the examples below may or may not describe limitations depending on the expected level of functioning for a given child's age. For example, a toddler would not be expected to be able to read, but a teenager would.
• Does not demonstrate an understanding of words that describe concepts such as space, size, or time (for example, inside/outside, big/little, morning/night).
• Cannot rhyme words or the sounds in words.
• Has difficulty remembering what was learned in school the day before.
• Does not use language appropriate for age.
• Is not developing “readiness skills” the same as peers (for example, learning to count, reciting ABCs, scribbling).
• Is not reading, writing, or doing arithmetic at appropriate grade level.
• Has difficulty comprehending written or oral directions.
• Struggles with following simple instructions.
• Talks only in short, simple sentences.
• Has difficulty explaining things.