Current estimates indicate that between 1% and 3% of individuals in the United States are diagnosed with mental retardation. This report delves into the methodology employed by the U.S. Social Security Administration (SSA) to identify individuals with cognitive impairments who face substantial challenges in their work capacity and may necessitate governmental support. It critically assesses the existing disability determination process in light of contemporary scientific understanding and clinical practices. Mental retardation, a condition marked by deficiencies in both intellectual abilities and adaptive behavior, presents unique diagnostic complexities, particularly when the disability falls within the mild spectrum.
SOCIAL SECURITY ADMINISTRATION DISABILITY PROGRAMS
The SSA oversees two primary disability programs designed to provide financial and healthcare assistance to individuals unable to work or function as expected for their age due to a disability. The Disability Insurance (DI) program, established under Title II of the Social Security Act, offers financial support to individuals previously employed who have contributed to the Social Security trust fund through payroll taxes. Certain dependents of insured individuals are also eligible for DI benefits. Conversely, the Supplemental Security Income (SSI) program, operating under Title XVI of the Social Security Act, provides payments to disabled individuals (including children under 18) with limited income and resources. SSI eligibility does not require prior employment or Social Security contributions, although it is subject to income and asset limitations.
The definition of disability is largely consistent across both DI and SSI programs. For DI applicants and adult SSI applicants, disability is defined as “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” (Social Security Administration, 2002, p. 4). Different criteria apply to children under 18, for whom disability is defined as a “medically determinable” physical or mental impairment, or combination thereof, causing “marked and severe functional limitations.” This impairment must be expected to result in death or persist for at least 12 continuous months. A medically determinable impairment is rooted in anatomical, physiological, or psychological abnormalities, substantiated by medical evidence including signs, symptoms, and laboratory findings, extending beyond subjective complaints.
Disability Determination Process
Navigating the application process for DI and SSI benefits can be lengthy and intricate. Individuals (or their guardians) can apply for disability benefits via phone, mail, or in person at a Social Security Office. The nearest office can be located by calling 1-800-772-1213 (or 1-800-325-0778 for TTY). Telephone applications can also be arranged through this number. SSA’s website (www.ssa.gov) offers comprehensive information on eligibility and application procedures.
A claims representative from SSA conducts the initial interview, either in person or by phone, to assess technical eligibility for DI or SSI benefits. If the eligibility criteria are met for either or both programs, the application, along with medical and vocational documentation, is forwarded to the state Disability Determination Services (DDS). Medical information submitted may include contact details for healthcare providers, treatment dates, current medications, medical records, and test results. Vocational information can encompass work history summaries and W-2 forms.
DDS is staffed by trained disability examiners and medical consultants who evaluate the submitted information to determine disability status. They may request additional information, potentially directly from the applicant’s treating physician, or require a consultative examination by an SSA-appointed examiner.
DDS disability determinations are based on a sequential evaluation process, outlined in Box 1-1.
Box 1-1
Sequential Evaluation Process for Disability Insurance and Social Security Income Benefits. Social Security regulations outline the sequential evaluation process used to evaluate applicants for disability benefits. Program rules further note that when (more…)
This sequential process involves five steps for adults and three for children. Beyond this initial determination, multiple levels of appeal exist, including hearings before an SSA administrative law judge, reviews by the Appeals Council, and ultimately, federal court review. This multi-stage process relies on both objective and subjective data, necessitating judgments from decision-makers, which inevitably introduces the possibility of errors. These errors can either wrongly deny benefits to eligible individuals or incorrectly grant benefits to ineligible individuals. Both types of errors carry significant costs for individuals and society, highlighting the importance of identifying and minimizing error sources inherent in disability criteria and assessment tools.
Criteria for Mental Retardation
For SSA disability determination, mental retardation is defined by “significantly sub-average general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22” (Social Security Administration, 2002, p. 76). For children, similar criteria apply, with the understanding that findings will naturally manifest within the developmental period (before age 22). The Listing of Impairments, which details medical criteria and diagnoses, provides specific guidelines for both adults, and children and adolescents with mental retardation. Listing 12.05 of Part A outlines the criteria for mental retardation eligibility for adults, requiring both the definition of mental retardation to be met and one of four additional requirements:
- Profound Mental Incapacity: Demonstrated mental incapacity evidenced by dependence on others for basic personal needs (toileting, eating, dressing, etc.) and an inability to follow simple directions, severe enough to preclude standardized intellectual functioning assessments.
- Extremely Low IQ: A valid verbal IQ (VIQ), performance IQ (PIQ), or full-scale IQ (FSIQ) of 59 or less.
- Low IQ with Additional Impairment: A valid VIQ, PIQ, or FSIQ between 60 and 70, coupled with a separate physical or mental impairment that significantly restricts work-related functioning.
- Low IQ with Functional Limitations: A valid VIQ, PIQ, or FSIQ between 60 and 70, alongside at least two of the following: (a) marked restriction in activities of daily living, (b) marked difficulties in social functioning, (c) significant deficiencies in concentration, persistence, or pace leading to task completion problems, or (d) recurrent episodes of decompensation.
Meeting any of these four criteria, in conjunction with the Diagnosis Of Mental Retardation, fulfills step 3 of the SSA determination process, establishing a prima facie case of disability resulting in work incapacity.
Separate criteria exist for children and adolescents, acknowledging the distinct impact of mental disorders on their development and functioning. These criteria are further categorized by age groups: infants and toddlers (1-3 years), and children and adolescents in age brackets of 3-6, 6-12, and 12-18 years. These age-specific criteria assess the severity of disability impact on functioning, with benefits provided for conditions causing “marked” restrictions, defined as “more than moderate but less than extreme.” A score two standard deviations below the mean on standardized tests is considered evidence of a marked restriction, while three standard deviations below indicates an extreme limitation.
Medical criteria for evaluating mental retardation in children are detailed in Listing 112.05. Similar to adults, the definition for children involves significantly subaverage general intellectual functioning and adaptive functioning deficits. Listing 112.05 outlines six criteria for assessing condition severity:
- Developmental Deficiencies: Deficiencies in motor, cognitive/communicative, or social functioning for infants and toddlers; and for older children and adolescents, deficiencies in at least two of these areas plus personal functioning or concentration, persistence, or pace leading to task incompletion.
- Severe Dependence: Dependence on others for personal needs grossly exceeding age expectations and an inability to follow directions so severe that standardized tests are not administrable.
- Extremely Low IQ: Valid VIQ, PIQ, or FSIQ of 59 or below.
- Low IQ with Coexisting Disorder: Valid VIQ, PIQ, or FSIQ between 60 and 70 and a coexisting physical or mental disorder significantly impairing functioning.
- Low IQ with Developmental/Functional Failure: Valid VIQ, PIQ, or FSIQ between 60 and 70 and, for infants/toddlers, failure to reach developmental milestones in motor, cognitive/communication, and social functioning consistent with children no more than two-thirds their age; for older children/adolescents, issues in cognitive/communication function, social function, personal function, or concentration, persistence, or pace.
- Developmental Failure with Coexisting Disorder: Failure of older infants/toddlers to achieve motor, cognitive/communicative, and social milestones of children no more than two-thirds their age, plus another physical or mental impairment significantly impacting function; for older children/adolescents, problems in cognitive/communicative, social, or personal function or deficiencies in concentration, persistence, or pace leading to task incompletion, and an additional physical or mental impairment.
HISTORY OF MENTAL RETARDATION DEFINITIONS
The SSA’s current definition of mental retardation diverges from those used by other professional and health organizations. The concept itself, acknowledging cognitive deficits significantly impacting functioning, has ancient roots, although its definition and measurement have evolved. Scheerenberger (1983) notes descriptions dating back to 1500 B.C. Egypt, detailing brain damage-related mental and physical disabilities.
Early definitions acknowledged cognitive differences linked to impaired functioning. In 1845, Esquirol (cited in Scheerenberger, 1983) categorized mental retardation based on speech and language task performance. Seguin (1866) emphasized a severe defect in moral development as the defining characteristic.
Sheerenberger (1983) suggests that by 1900, major concepts of modern definitions were in use in the US: developmental period onset (before 22), intellectual deficits, and daily life coping problems. In 1910, the precursor to today’s American Association on Intellectual and Developmental Disabilities (AAIDD), then called the American Association on Mental Deficiency, issued its first formal definition, classifying individuals as “feeble-minded” with arrested development or inability to manage daily life or keep pace with peers (Committee on Classification of Feeble-Minded, 1910). Levels of impairment were further categorized: “idiots” (development of a 2-year-old), “imbeciles” (2-7 years), and “morons” (7-12 years).
Following this definition, debate arose whether mental retardation was constitutional or based on social competence deficits (Biasini et al., 1999). Edgar Doll (1936a) proposed a genetic origin leading to social incompetence and arrested development, deeming it incurable. Conversely, Kuhlman (1920) posited a subnormal developmental rate due to social functioning deficits, not genetics. Despite these definitional differences, focus remained on inability to perform common behaviors, social development delays, and low intelligence (Yepsen, 1941).
The 1959 AAIDD definition formally integrated intellectual capabilities and adaptive behavior, defining mental retardation as “subaverage general intellectual functioning which originates in the developmental period and is associated with impairment in adaptive behavior” (Jacobson, 1999). Subaverage IQ was defined as 85 or less, with the developmental period ending at 16. Adaptive behavior deficits became a necessary component, though formal measures were lacking. The Vineland Social Maturity Scale (Doll, 1953) was recommended, with subjective clinician interpretation. A five-level classification included borderline (IQ 67-85), mild (IQ 50-66), moderate (IQ 33-49), severe (IQ 16-32), and profound (IQ < 16).
AAIDD revised its definition in 1973, partly due to concerns about minority student over-identification as mentally retarded. Borderline retardation was eliminated, and the IQ criterion lowered from 85 to 70 or below (Grossman, 1973), significantly reducing the number of children eligible for special services and support. Retardation levels were also slightly redefined.
Further revision came in 1977, suggesting IQs of 70-75 could indicate mental retardation with significant adaptive behavior deficits (Grossman, 1977), accounting for the standard error of measurement in IQ tests. The most recent AAIDD definition, adopted in 1992, removed retardation levels (American Association on Mental Retardation, 1992), and listed 10 adaptive skill areas, requiring deficits in at least two for diagnosis.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) merged the 1977 and 1992 AAIDD definitions, retaining 1972 severity levels and adopting similar adaptive behavior areas. DSM-IV also kept the IQ upper limit at 70 or less.
It’s crucial to recognize that SSA’s definition differs from major professional organizations due to its purpose: program eligibility, not diagnosis. The SSA definition effectively identifies individuals with cognitive limitations significantly impacting their work capacity, thus potentially needing governmental support.
PREVALENCE OF MENTAL RETARDATION
In the General Population
Prevalence estimates of mental retardation in the U.S. population vary widely due to differing definitions, diagnostic methods, and populations studied. DSM-IV estimates 1% prevalence, without explicit justification (American Psychiatric Association, 1994), similar to other researchers (Hodapp & Dykens, 1996). Baroff (1991), using empirical sampling, estimates 0.9%. McClaren and Bryson’s (1987) review of epidemiological studies reports 1.25% based on total population screening. The U.S. Department of Education (1994) reports state-level prevalence for special education eligibility ranging from 0.3% to 2.5%. In contrast, the U.S. Surgeon General estimates 7.5 million Americans with mental retardation, nearly 3% of the population.
The Centers for Disease Control and Prevention’s Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) monitors developmental disability prevalence, including mental retardation, in children aged 3-10 in Atlanta (Boyle et al., 1996), using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) definition (World Health Organization, 1988), which includes severity levels. MADDSP found an overall prevalence of 8.7 per 1,000 children aged 3-10 in Atlanta, with mild severity in about two-thirds of cases. Prevalence varied by age, from 5.2/1,000 (3-4 years) to 12.3/1,000 (9-10 years), with increases primarily in mild and moderate ranges.
These rates align with National Health Interview Survey analyses. Halfon and Newacheck (1999), using the ICD-9 definition, reported unadjusted prevalence of 10.5/1,000 for children under 18. Prevalence increased with age: 2.0/1,000 (<6 years), 14.7/1,000 (6-12 years), and 15.7/1,000 (12-17 years). Prevalence was also higher for males (13.0/1,000) than females (7.9/1,000).
Racial/ethnic disparities exist, with higher prevalence among Black youth (16.2/1,000) compared to White (9.8/1,000), Hispanic (9.0/1,000), and other (6.4/1,000) youth. Parental reporting in the National Health Interview Survey, potentially influenced by cultural factors, may contribute to these differences. The strong correlation between low socioeconomic status and mental retardation (Chapter 2) and higher poverty rates among Black and Hispanic youth are also contributing factors.
These prevalence estimates vary significantly, from 1% to almost 3%. The actual prevalence likely falls between 1% and 3%, suggesting 2.8 to 7.5 million individuals could be diagnosed with mental retardation.
In the Social Security System
Individuals diagnosed with mental retardation constitute a substantial portion of SSA disability benefit recipients. SSA’s Annual Statistical Supplement (2001a) data from December 2000 indicates 567,151 individuals with mental retardation received DI benefits, including 257,601 workers, 299,925 adults aged 18+, and 9,625 widows/widowers, representing 10% of all disabled workers.
The SSI program shows similarly high recipient numbers with mental retardation. Among child SSI recipients in December 2000, mental retardation was the largest diagnostic group at 32.8% (261,200 individuals). Consistent with epidemiological data, boys (162,230) outnumbered girls (98,880) in this group (Social Security Administration, 2001b).
December 2000 data also highlights high adult SSI recipient numbers with mental retardation (Social Security Administration, 2001a). Mental retardation constituted 25.7% of adult SSI beneficiaries, the second-largest diagnostic group (“all other mental disorders” being the largest at 34.4%). Males (52.5%) slightly outnumbered females (47.5%) among adult SSI recipients with mental retardation.
ISSUES THAT PROMPTED THE CURRENT STUDY
This study was initiated to evaluate the SSA’s disability determination process for mental retardation. The committee was tasked with examining recent scientific advancements and practical techniques to enhance the current process, suggest new procedures responding to these developments, and identify promising research opportunities to address unresolved questions. The SSA is particularly concerned with accurate diagnosis of mental retardation in the mild range.
This report leverages recent research in cognition, learning, neural processes during thinking and learning, and the development of learned competencies like social and practical skills. Decision science research also informs SSA policy considerations. Key issues prompting this study include:
- Adequacy of the SSA Definition: Evaluating if the SSA’s definition of mental retardation aligns with current scientific and clinical understanding.
- Intellectual Assessment Questions: Examining the methods and tools used to assess intellectual functioning in the disability determination process.
- Adaptive Behavior Assessment Issues: Addressing the challenges and best practices in assessing adaptive behavior.
- Combining Intellectual and Adaptive Behavior Data: Developing effective strategies for integrating data from both types of assessments, especially in mild cases.
- Differential Diagnosis Challenges: Improving the ability to differentiate mental retardation from other conditions with similar symptoms, particularly in children and adolescents.
Public Policy Implications
The diagnosis of mental retardation and benefit receipt have significant public policy implications, relating to program context and benefit impact. Recipients receive income maintenance and healthcare coverage through Medicaid, crucial for chronic medical condition treatment. SSA definition changes have historically impacted benefit recipient numbers. Any practice review must consider potential negative effects on beneficiaries and the disability program. This committee’s assessment includes an analysis of these policy issues.
Adequacy of the SSA Definition
The SSA definition of mental retardation centers on subaverage intellectual functioning, either alone or with other disabilities or functional impairments, with onset before age 22 (diagnosis can occur at any age). This definition differs from those of organizations like the American Psychiatric Association (DSM-IV), AAIDD, WHO (ICD-10), and the American Psychological Association’s Division 33.
DSM-IV defines mental retardation as significantly subaverage intellectual functioning (IQ approximately two standard deviations below the mean), with significant adaptive functioning limitations in at least two of 11 areas (communication, functional academics, health, home living, leisure, safety, self-care, self-direction, social/interpersonal skills, community resource use, and work), and onset before age 18. DSM-IV categorizes severity into mild (IQ 50-55 to 70), moderate (IQ 35-40 to 50-55), severe (IQ 20-25 to 35-40), and profound (IQ < 20 or 25) (American Psychiatric Association, 1994).
AAIDD defines mental retardation by substantial limitations in present functioning, including subaverage intellectual functioning and deficits in at least two of 10 adaptive skill areas (communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work), manifested before age 18. AAIDD classifies based on support needs: intermittent, limited, extensive, or pervasive (American Association on Mental Retardation, 1992).
WHO’s ICD-10 defines mental retardation as “a condition of arrested or incomplete development of the mind,” characterized by impaired skills (cognitive, language, motor, and social) during the developmental period. An IQ below 70 is indicative. ICD-10 recommends culturally relevant standardized measures of social maturity and adaptation for functional assessment, but lacks adaptive behavior deficit cutoff guidelines. ICD-10 allows for mental retardation diagnosis with coexisting mental or physical disorders.
Division 33 of the American Psychological Association defines mental retardation as “(a) significant limitations in general intellectual functioning; (b) significant limitations in adaptive functioning, which exist concurrently; and (c) onset of intellectual and adaptive limitations before the age of 22 years” (Jacobson & Mulick, 1996). Significant limitations are defined as two or more standard deviations below the population mean on standardized assessments.
These definitions differ from SSA’s primarily in age of onset (18 vs. 22) and the nature and measurement of adaptive functioning deficits. WHO and Division 33 advocate standardized adaptive behavior assessments, while AAIDD and the American Psychiatric Association allow for functional deficit descriptors across domains. Even with descriptors, the required number of deficient areas varies. The American Psychiatric Association requires deficits in at least 2 of 11 areas, and AAIDD in at least 2 of 10. SSA, however, does not specify the number of areas, relying on “marked” restrictions in daily living and social functioning. It is important to reiterate that SSA uses its definition for program eligibility, ensuring just and correct federal resource allocation, not for clinical diagnosis.
Intellectual Functioning and Its Assessment
SSA aligns with other organizations regarding the level of intellectual impairment for a mental retardation diagnosis (IQ no higher than two standard deviations below the mean). However, while others use summary scores on intellectual functioning measures (e.g., Wechsler FSIQ), SSA accepts part scores from individually administered IQ tests, citing Wechsler part scores (VIQ, PIQ) in regulations.
While SSA encourages standardized tests for intellectual and adaptive behavior assessment, they are not mandatory. SSA inadvertently favors Wechsler tests by mentioning that the lowest of FSIQ, VIQ, and PIQ can be used, creating disparity without empirical or policy basis. It raises the question of which score provides the most relevant information. FSIQ has higher reliability and validity than part scores. SSA needs to determine if using the lowest of multiple IQ scores (FSIQ, VIQ, PIQ) is scientifically and practically sound.
SSA’s cutoff scores of 59 or less and 60-70 also need to be evaluated against current scientific literature. The stringent upper limit fails to account for the standard error of measurement in IQ tests. These assessment issues are further complicated by cultural and linguistic diversity. Instruments may be unavailable in native languages, or norming procedures may be unsuitable for certain subpopulations.
It is crucial to assess the adequacy of major instruments like the Wechsler scales and Stanford-Binet for intelligence assessment in diverse cases. If inadequate, clinically acceptable and programmatically workable alternatives, including nonverbal and multilingual instruments with sufficient reliability and validity, should be explored for diagnosing mental retardation. These alternatives should be practical for widespread clinical use.
Research advances in developmental functioning assessment have broadened intelligence examination beyond verbal and performance IQ scores to encompass process and product measures. Components like attention, computation, problem-solving, and performance processes can now be more easily differentiated.
In developmental assessment, standardized preschool competence measures (Bayley, 1993) are needed to assess multiple functioning domains, including motor, cognitive, communication, and social skills. Impairment judgments based solely on verbal and performance IQs may not reflect current intelligence testing practices for preschool children. The committee was tasked with determining if other instruments better assess young children’s intellectual functioning.
Adaptive Behavior Functioning and Its Assessment
For individuals with IQ scores above 59, SSA requires adaptive behavior and functioning deficit documentation for a mental retardation classification, absent other serious medical conditions. This evidence may include standardized test results (e.g., Scales of Independent Behavior-Revised, Vineland Adaptive Behavior Scales) or descriptions from parents, teachers, or clinicians. This reflects practice variation in the field. AAIDD and the American Psychiatric Association allow behavioral descriptors for diagnosis, while Division 33 and WHO suggest standardized assessments (Jacobson & Mulick, 1996).
SSA seeks advice on best practices for adaptive behavior assessment for eligibility determination. Current practice may yield diverse information types from various sources. Lack of standardization may cause difficulties. Claims may be adjudicated on varied data, and trained examiners must combine this data, with medical consultant input, to identify adaptive behavior deficits, potentially leading to inconsistent decisions and lengthy processes.
Key issues include the effectiveness of current measures of communicative, social, personal, motor, and community living skills in identifying and quantifying adaptive behavior deficits, and their reliability and validity. The committee explored clinically acceptable and programmatically workable alternatives, as well as unsatisfactory current measures.
Combining IQ and Adaptive Functioning Data
Describing behavioral deficits is most critical and challenging for individuals with IQs near 70. SSA currently combines standardized IQ data with varied adaptive functioning information. Adult disability examiners consider occupational and social adjustment and self-care. For children, adjustment and developmental expectations are key. However, consistent guidelines for combining these data types are lacking.
SSA is interested in each measure’s unique contribution to analyzing individual adjustment. A subset is their contribution to evaluating and diagnosing borderline mental retardation cases (IQs near 70).
Current SSA practices allow significant qualitative performance evaluation. Advances in adaptive functioning studies offer a more nuanced view of social and personal competence. Reviewing current thinking on adaptive functioning dimensions could yield new assessment models, improve older assessments by updating cutoff scores, or justify functional area alterations in the eligibility determination process. The committee reviewed qualitative adaptive functioning assessments and standardized evaluation instruments.
Differential Diagnosis
Differentiating mental retardation from conditions with similar cognitive and behavioral manifestations (differential diagnosis) is crucial. SSA faces challenges distinguishing mental retardation from other disorders in children and adolescents. The 1990 Sullivan v. Zebley decision, relaxing child SSI eligibility criteria, alongside determination criteria changes from the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Balanced Budget Act of 1997, have drawn criticism of SSA’s efforts to differentiate mental retardation from other cognitive disabilities.
Conditions like autism, learning disabilities, borderline intellectual functioning, and organic mental disorders (e.g., traumatic brain injury) share overlapping features with mental retardation. Genetic and behavioral disorders also present similar features.
The committee reviewed these diagnoses, evaluating overlapping signs and symptoms, and is providing SSA with recommendations for better distinguishing these cognitive, genetic, and behavioral disorders from mental retardation.
Additional Research Needs
Evaluating scientific evidence comprehensively requires identifying further research to improve mental retardation assessment and diagnosis. This is crucial for ensuring appropriate services from education, health, and social service agencies for individuals with mental retardation. This question addresses SSA and benefit recipient long-term needs.
STUDY APPROACH
The committee and staff conducted extensive literature reviews on mental retardation and its assessment, gathering information from diverse sources to assess evidence strengths and weaknesses, aiming for convergent information from descriptive and inferential data and theoretical frameworks.
Literature searches in peer-reviewed journals, reviews of intelligence and adaptive behavior measure technical manuals, commissioned expert papers, and feedback solicitation from professional practice, advocacy, and relevant groups were conducted. Members also reviewed SSA and other government agency technical and policy literature to understand disability programs and benefits for individuals with mental retardation. To understand practical and policy implications of benefit receipt recommendations, Monte Carlo simulations were used to examine the consequences of altering intelligence and adaptive behavior score criteria. The committee particularly focused on mild mental retardation, the most complex area.
ORGANIZATION AND SCOPE OF THE REPORT
This report focuses on specifying mental retardation determination criteria for SSI/DI eligibility, examining contextual issues affecting SSA disability benefit programs, recognizing public policy impacts of determination process evaluations (Chapter 2). SSA’s charge to the committee included several questions: the adequacy of current IQ tests reflecting intelligence concepts (Chapter 3), the best definition and assessment of adaptive functioning (Chapter 4), the relationship between intelligence and adaptive behavior measures (Chapter 5), and differential diagnosis (Chapter 6). Research needs are mentioned throughout and summarized in Chapter 5.
Focusing on determination criteria for SSI/DI eligibility, this report addresses intellectual and adaptive behavior criteria for initial eligibility determinations for all potential beneficiaries (children, adolescents, and adults).
The committee has not explicitly addressed eligibility redetermination (periodic recertification), which occurs at intervals based on medical condition (every 7 years for unlikely changes, every 3 for potentially improving conditions, and as soon as 18 months for likely near-term improvement). Mental retardation redeterminations are every 7 years. The report’s outlined standards for intellectual functioning and adaptive behavior assessment are considered applicable to the redetermination process as well.
