Speech and Language Disorders in Children Implications for the Social Security Administration's Supplemental Security Income Program (2016) / Chapter Skim
Currently Skimming:
5 Comparison of Trends in Childhood Speech and Language Disorders in the General Population and the Supplemental Security Income Program Population
5 Comparison of Trends in Childhood Speech and Language Disorders in the General Population and the Supplemental Security Income Program Population
Pages 159-206
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 159... ...
Nevertheless, available research and datasets make it possible to draw evidence-based conclusions related to some basic issues concerning these trends -- in particular, those issues that may directly impact the nature and size of the population of children receiving SSI benefits based on having these disorders. It was also possible to draw conclusions about gaps in knowledge that need to be addressed to provide more precise information about the prevalence of speech and language disorders among both the general population of children and those receiving SSI benefits on the basis of having these disorders.
|
From page 160... ...
. Population data from national surveys typically are based on parent or guardian identification of speech and language disorders in children, and clinical corroboration of the condition or treatment received by the child is rare.
|
From page 161... ...
To examine trends in the number of speech and language disorders among children receiving SSI benefits, the committee used data from the Social Security Administration (SSA)
|
From page 162... ...
Just as the Medicaid population does not include all children with speech and language disorders, the SSI population with childhood disabilities does not include all children with speech and language disorders or even all children with disabilities. The eligibility and determination process required to qualify for the SSI program produces a beneficiary population that is very different from the general population of children with speech and language disorders in the United States (see Chapter 4)
|
From page 163... ...
While the Survey of Income and Program Participation is longitudinal, and participants can be studied over time, disability questions are asked only once. It is also important to emphasize that, with few exceptions (e.g., the National Survey of Children with Special Health Care Needs and the National Health Interview Survey -- Voice, Speech, and Language Supplement)
|
From page 164... ...
had a speech problem? National Health Interview Numerous survey questions related to "speech Yes No Yes Survey -- Voice, Speech, problems,"including: and Language Supplement Did a health or education professional EVER tell you a diagnosis or reason for [child's name]
|
From page 165... ...
Individuals with Percentage of children reported by local education No No No Disabilities Education Act agencies as having a primary disability of "speech (IDEA) child count data or language impairment" Medicaid claims data ICD-9*
|
From page 166... ...
National Health Interview Survey The National Health Interview Survey is a cross-sectional survey based on personal household interviews. It serves as the principal source of information on the health of the civilian noninstitutionalized population of the United States and is administered by the National Center for Health Statistics (CDC, 2012a)
|
From page 167... ...
National Survey of Children with Special Health Care Needs The National Survey of Children with Special Health Care Needs was a national cross-sectional telephone survey administered by the National Center for Health Statistics. Its purpose was to gather information on the health and functional status of children with special health care needs, including their physical, emotional, and behavioral health; their health care access; their service utilization and its quality; and the impact of chronic conditions on their family (DRC, 2012c)
|
From page 168... ...
A study commissioned by the SSA in 2001-2002 found that about 10 percent of child SSI recipients had been missed by the special needs screener, and of those who had been missed, 53 percent had intellectual disability; 8 percent had speech disturbances; 4 percent had other specific learning difficulties; 4 percent had attention deficit hyperactivity disorder/attention deficit disorder; and the rest had a wide range of physical, cognitive, and behavioral conditions (Ireys et al., 2004)
|
From page 169... ...
First, it collected no information about receipt of SSI benefits, nor did it collect detailed information about speech therapy or other service utilization, etiology, age at time of child's diagnosis, receipt of social welfare benefits, or measures of poverty or family well-being. Second, all the information collected is based on parent or guardian reports, with no clinical corroboration of a child's condition.
|
From page 170... ...
Each state reports the number of children receiving special education services funded in part by federal monies from IDEA Part B (ages 3-21) or Part C (ages birth through 2 years)
|
From page 171... ...
A subsequent section presents estimates of trends in the child SSI program population based on administrative or service data. Estimates of the prevalence of childhood speech and language disorders in the general population vary depending on the survey data that are used.
|
From page 172... ...
1.0% 0.0% 2005/6 2009/10 Year FIGURE 5-1 Proportion of children with speech and language disorders in the general U.S. population based on the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs.
|
From page 173... ...
Administrative data from IDEA suggest that, relative to their proportion of the general U.S. population (2-15 percent for those aged birth-21, as 6.0% 26% 6% Proportion of Children with Speech and Language Disorders rease increase 5.0% 4.8% 48 4.0% 3 8% 3.8% Has a doctor or other health care provider ever told you that [child]
|
From page 174... ...
With respect to trends in prevalence, IDEA data stand in contrast to the survey data reported above, indicating that the prevalence of speech and language disorders among children receiving IDEA services remained steady from 2003 to 2012. Why the prevalence of speech and language disorders as measured by the National Survey of Children's Health and the National Survey of
|
From page 175... ...
. IDEA child count data show that the percentage of children with speech or language impairments is considerably higher in the younger age group
|
From page 176... ...
. The National Health Interview Survey -- Voice, Speech, and Language Supplement shows the prevalence of voice, speech, swallowing, or language problems to be 4.3 percent of all boys versus 2.2 percent of all girls (Hoffman, 2015)
|
From page 177... ...
As is evident, the percentage of children reported to have speech and language disorders increased over time within each racial or ethnic group. Figure 5-6 shows the prevalence of speech and language disorders in children by race/ethnicity based on the National Health Interview Survey -- Voice, Speech, and Language Supplement.
|
From page 178... ...
Figure 5-5 4.0% 3.7% 3.7% Speech or Language Problems Prevalence 3.5% 3.0% 3.0% 2.7% 2.6% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Non-Hispanic Hispanic Non-Hispanic Asian Other Children Black White Race/Ethnicity FIGURE 5-6 Prevalence of speech and language disorders among children aged 3-17 years based on the National Health Interview Survey -- Voice, Speech, and Language Supplement.
|
From page 179... ...
. In data from the National Health Interview Survey -- Voice, Speech, and Language Supplement (2012)
|
From page 180... ...
SOURCE: 2010 Survey of Income and Program Participation. 21% < 100% FPL 56% 100–199% FPL 23% ≥ 200% FPL FIGURE 5-8 Children aged 6-17 without speech and language disorders, by family income relative to the federal poverty level (FPL)
|
From page 181... ...
SOURCE: 2010 Survey of Income and Program Participation. are more likely than households that do not experience such hardship to have children with speech and language disorders (NBER, 2015)
|
From page 182... ...
Comorbidities As discussed in Chapter 2, children with speech and language disorders have a high likelihood of experiencing other problems as well. Based on the 2000-2012 National Health Interview Survey, more than 40 percent of children with speech and language disorders experience such comorbidities as developmental delay3 (32 percent)
|
From page 183... ...
Impairments determined through the SSA process can be either primary -- where the child's chief presenting problem is a speech or language impairment -- or secondary -- where the child has been determined to have another impairment for which a speech or language impairment is a comorbidity or a secondary impairment. As described in detail in Chapter 2, speech and language impairments are commonly associated with a variety of other developmental disorders, including disorders that may themselves result in a child's qualifying for SSI benefits (e.g., autism spectrum disorder, attention deficit hyperactivity disorder, intellectual disability)
|
From page 184... ...
The numbers of initial determinations, denials, and initial allowances for speech and language disorders are shown in Figure 5-11. An initial determination refers to a decision made by Disability Determination Services as to whether a child is allowed or denied SSI benefits based on disability.
|
From page 185... ...
The numbers of allowances for primary speech and language impairment over an 11-year period are shown in Figure 5-12. The figure also shows increases in allowances within the SSI program during years that correspond to the years of administration of the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health.
|
From page 186... ...
SOURCE: Unpublished dataset provided by the Social Security Administration. The 27 percent increase in SSI allowances for children with speech and language impairments is markedly lower than the 56 percent increase in prevalence of these disorders reported by the National Survey of Children with Special Health Care Needs between 2005-2006 and 2009-2010.
|
From page 187... ...
Thus, a 24.2 percent increase in the number of annual initial allowances leads to a much larger 171 percent increase in the total number of beneficiaries over time because once qualified for SSI, few children with severe speech and language disorders subsequently become ineligible for the program. In 1994, the first year in which the new impairment code (3153)
|
From page 189... ...
COMPARISON OF TRENDS 189 # of Initial Allowances Each Year FIGURE 5-14 Illustration of how the total number of children receiving SSI benefits grew over time as a result of the addition of a new category, fiscal years 1994-2014. SOURCE: Unpublished dataset provided by the Social Security Administration.
|
From page 190... ...
. Thus, the total number of children receiving SSI benefits for speech and language impairments in 2013 will include almost all of the children who became eligible in the years from 1996 through 2013, but will not include children who became eligible in 1994 or 1995.
|
From page 191... ...
SOURCE: Unpublished dataset provided by the Social Security Administration. Figure 5-15 Between 2008 and 2014, autism spectrum disorder, attention deficit hyperactivity disorder, and learning disability were the most frequent comorbid conditions associated with an allowance based on a primary speech or language impairment.
|
From page 192... ...
Figure 5-17 shows suspensions from the SSI program from 2004 through 2013. Notably, these data are for all children receiving SSI ben efits, not just those with speech and language disorders as has been the case previously in this section.
|
From page 193... ...
Concentration of Lowest-Income Children Within the Supplemental Security Income Program Resulting from Suspensions and Terminations The net result of suspending and terminating higher-income children from the SSI program is the concentration of children from the poorest
|
From page 194... ...
TRENDS IN CHILDHOOD SPEECH AND LANGUAGE DISORDERS AMONG MEDICAID BENEFICIARIES Medicaid data are administrative and can be used to examine comorbid conditions and services among children receiving treatment for a medical diagnosis. As described below, entry into the SSI program establishes eligibility for Medicaid in most states.
|
From page 195... ...
establish trends in the prevalence of speech and language disorders among children with these disorders enrolled in the SSI program. Established in July 1965 as Title 19 of the Social Security Act, Medicaid is the dominant insurer of low-income adults and children in the United States today.
|
From page 196... ...
states" that use criteria more restrictive than those of the SSI program to determine Medicaid eligibility for their residents; in these states, meeting SSI eligibility criteria does not guarantee Medicaid eligibility (SSA, 2014)
|
From page 197... ...
An analysis of Medicaid claims data from 20 states conducted by a team at Rutgers University sheds light on speech and language disorders among participants in the SSI and Medicaid programs. The Rutgers team examined claims data for children aged 3-17 with 11+ months of continuous Medicaid eligibility and no dual eligibility in a given year.
|
From page 198... ...
Both of these trends support the increasing prevalence of speech and language disorders among children receiving SSI discussed earlier in this chapter. Irrespective of mode of entry, the two programs are highly complementary, with Medicaid resourcing the health care needs of children and SSI resourcing the added costs associated with raising children with speech and language disorders.
|
From page 199... ...
One approach is to examine additional diagnostic codes within the claims of children with a diagnosis of speech or language disorder. Using this strategy, the Rutgers University team determined that the most commonly occurring comorbid diagnosis in the claims of children with speech and language disorders is attention deficit hyperactivity disorder.
|
From page 200... ...
Consequently, the committee was unable to answer questions related to treatment and service utilization among those eligible for Medicaid because of SSI program participation. DATA STRENGTHS AND LIMITATIONS This chapter has relied on three different types of data: clinical data drawn from small treatment studies; population data drawn from large national surveys; and service (administrative)
|
From page 201... ...
In addition, the questions used to ascertain speech and language disorders in these national surveys result in the identification and inclusion of children with relatively milder forms of the disorders. In contrast, children who are eligible for Medicaid because of SSI program participation are likely to have the most severe limitations.
|
From page 202... ...
5-6. The number of children receiving SSI benefits for a primary speech or language impairment increased by 171 percent between 2004 and 2014.
|
From page 203... ...
5-8. The most commonly occurring comorbid diagnosis in the Medicaid claims of children with speech and language disorders is attention deficit hyperactivity disorder, seen in between 6.7 and 11.5 percent of children on Medicaid.
|
From page 204... ...
the introduction in 1994 of a new impairment code for speech and language impairment, and (2) the marked and extreme levels of impairment among chil dren who receive SSI benefits for speech and language disorders that are unlikely to be resolved by the time a child reaches age 18.
|
From page 205... ...
2012a. About the National Health Interview Survey.
|
From page 206... ...
Workshop presentation to the Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders, May 18, Washington, DC.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.