Friday, October 30, 2009

Work and Social Security Programs—Impact on AD/HD

My 19-year-old son is in a post-high school program that offers trial work assignments, independent living skills, and social skills, combined with some community college. We are hopeful that he will develop work skills. Social challenges are his most immediate challenge. The prospect of no health insurance because of a lack of full-time employment with a large employer is a longer-term concern (and thus our support for national health care reform). With time and support, work should be a realistic goal.

At CHADD’s 21st annual international conference two weeks ago in Cleveland, we had two sessions on work, economic crisis, and Social Security programs. Rick Tully with the Ohio Department of Mental Health presented an overview of government programs to assist in times of economic hardship. These included the Social Security Administration (SSA) income assistance programs—Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). To qualify for SSI and SSDI, one must not be able to “engage” in “substantial gainful activity” and one must have a documentable medically determinable disability.

Tom Gloss of the Social Security Administration conducted a session on the Ticket-to-Work—Work Incentives Program. Ticket to Work is a program for persons already on SSI or SSDI who want to work.

AD/HD is a qualifying medical disability for SSI for children. One has to have substantial limitations, but it is a qualifying disability. There are 194,026 children (under age 18) on SSI with a primary or secondary diagnosis of AD/HD.

Currently, there are no SSA medical disability criteria for AD/HD in adults. The law requires that there be a medically determinable impairment and that there be substantial functional limitations. Adults who meet the Diagnostic and Statistical Manual (DSM) criteria for AD/HD would meet the medically determinable impairment criteria. Then, SSA would determine the severity of disability and its relation to work. Failure to precisely list AD/HD in adults will be a major roadblock to some individuals becoming eligible for SSDI or SSI. There are no SSA regulations preventing an adult with AD/HD from becoming eligible.

For any of the mental disorders, one must have substantial limitations in specific areas such as activities of daily living, concentration, social interaction, and ability to adapt to changes in the environment.

The challenge: Many people with AD/HD and related disorders don’t have the severity of limitations to meet the SSI and SSDI test. But they also may not have the ability to sustain permanent and consistent full-time work. Finding a social policy that encourages work, reduces disability, and provides health insurance—while keeping the social safety net of SSI and SSDI—is a very difficult challenge. CHADD continues to work with national public policy makers to address these difficult issues.


You can read this blog and others like it at the HealthCentral website.


Anonymous said...

I applaude your efforts to collaborate with other "like minded" entities to provide support and options for adult, especially young adults with AD/HD. I am concerned about the many changes and reduction in support that my daughter, diagnosed with AD/HD and co-existing conditions, has encountered after she turned 18 (now almost 19.) She has difficulty maintaining "full time" student status at her local community college; is threatened with losing insurance coverage and would be unable to obtain a part time or full time job that gives her coverage. Just because she suddenly became "an adult" her opportunities to learn and mature at her own pace are uncertain. Changes in legislation and government support must be pursued to support young adults with AD/HD so that they, once again, don't "fall through the cracks" of an unforgiving system. Thanks for your continued efforts!

CHADD of Grand Rapids said...

I didn't realize that AD/HD is considered to be a disability under SSI for children with AD/HD, but not for adults. It sounds similar to what we experienced before AD/HD was "named" under special education law. A greater burden of proof was required to substantiate impairment. For a young adult trying to access services, it would seem that this could be the difference between perceiving that society wants them succeed, and doesn’t. I agree with Catherine's comment about our children falling through the cracks as young adults. At the very time they are taking on adult responsibilities with adult consequences, and can no longer have their parents advocate for them, they are expected to advocate for themselves--without benefit of treatment. If young adults could have access to continuous mental health treatment, perhaps they wouldn’t end up limiting their options in life further, by what they do while “in the crack.” I shared information from the excellent Law Enforcement Pre-Conference session, at the CHADD Conference, earlier this month, with several agencies involved in a new Jail to Community Initiative in our county. I also brought information from the Ticket to Work session to our county’s Center for Independent Living. We have to start someplace!